|
PR EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
CPT 11604
|
| Hospital Charge Code |
11604
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$328.23 |
| Max. Negotiated Rate |
$1,931.58 |
| Rate for Payer: Aetna Commercial |
$442.85
|
| Rate for Payer: Aetna Medicare |
$713.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$338.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.75
|
| Rate for Payer: BCBS Complete |
$386.19
|
| Rate for Payer: BCBS MAPPO |
$686.20
|
| Rate for Payer: BCN Medicare Advantage |
$686.20
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Cofinity Commercial |
$364.70
|
| Rate for Payer: Cofinity Commercial |
$448.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$364.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Healthscope Commercial |
$468.90
|
| Rate for Payer: Mclaren Medicaid |
$367.80
|
| Rate for Payer: Mclaren Medicare |
$686.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.51
|
| Rate for Payer: Meridian Medicaid |
$386.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.85
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Commercial |
$442.85
|
| Rate for Payer: PHP Medicare Advantage |
$686.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.65
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Priority Health SBD |
$328.23
|
| Rate for Payer: Railroad Medicare Medicare |
$686.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,931.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.20
|
| Rate for Payer: UHC Medicare Advantage |
$686.20
|
| Rate for Payer: UHCCP Medicaid |
$386.33
|
| Rate for Payer: VA VA |
$686.20
|
|
|
PR EXCISION MAXILLARY TORUS PALATINUS
|
Professional
|
Both
|
$793.00
|
|
|
Service Code
|
HCPCS 21032
|
| Min. Negotiated Rate |
$247.82 |
| Max. Negotiated Rate |
$515.45 |
| Rate for Payer: Aetna Commercial |
$332.08
|
| Rate for Payer: Aetna Medicare |
$257.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$356.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$332.08
|
| Rate for Payer: BCBS Complete |
$317.20
|
| Rate for Payer: BCBS MAPPO |
$247.82
|
| Rate for Payer: BCN Medicare Advantage |
$247.82
|
| Rate for Payer: Cash Price |
$634.40
|
| Rate for Payer: Cash Price |
$634.40
|
| Rate for Payer: Cofinity Commercial |
$356.86
|
| Rate for Payer: Cofinity Commercial |
$332.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$247.82
|
| Rate for Payer: Healthscope Commercial |
$458.47
|
| Rate for Payer: Healthscope Commercial |
$396.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$260.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$515.45
|
| Rate for Payer: Nomi Health Commercial |
$297.38
|
| Rate for Payer: PACE SWMI |
$247.82
|
| Rate for Payer: PHP Medicare Advantage |
$247.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.45
|
| Rate for Payer: Priority Health Medicare |
$247.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$247.82
|
| Rate for Payer: UHC Medicare Advantage |
$247.82
|
|
|
PR EXCISION MULTIPLE EXTERNAL PAPILLAE/TAGS ANUS
|
Professional
|
Both
|
$679.00
|
|
|
Service Code
|
HCPCS 46230
|
| Min. Negotiated Rate |
$167.58 |
| Max. Negotiated Rate |
$441.35 |
| Rate for Payer: Aetna Commercial |
$224.56
|
| Rate for Payer: Aetna Medicare |
$174.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.56
|
| Rate for Payer: BCBS Complete |
$271.60
|
| Rate for Payer: BCBS MAPPO |
$167.58
|
| Rate for Payer: BCN Medicare Advantage |
$167.58
|
| Rate for Payer: Cash Price |
$543.20
|
| Rate for Payer: Cash Price |
$543.20
|
| Rate for Payer: Cofinity Commercial |
$241.32
|
| Rate for Payer: Cofinity Commercial |
$224.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.58
|
| Rate for Payer: Healthscope Commercial |
$268.13
|
| Rate for Payer: Healthscope Commercial |
$310.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$175.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$441.35
|
| Rate for Payer: Nomi Health Commercial |
$201.10
|
| Rate for Payer: PACE SWMI |
$167.58
|
| Rate for Payer: PHP Medicare Advantage |
$167.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$441.35
|
| Rate for Payer: Priority Health Medicare |
$167.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$167.58
|
| Rate for Payer: UHC Medicare Advantage |
$167.58
|
|
|
PR EXCISION NAIL MATRIX PERMANENT REMOVAL
|
Professional
|
Both
|
$483.00
|
|
|
Service Code
|
HCPCS 11750
|
| Min. Negotiated Rate |
$96.12 |
| Max. Negotiated Rate |
$313.95 |
| Rate for Payer: Aetna Commercial |
$128.80
|
| Rate for Payer: Aetna Medicare |
$99.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.80
|
| Rate for Payer: BCBS Complete |
$193.20
|
| Rate for Payer: BCBS MAPPO |
$96.12
|
| Rate for Payer: BCN Medicare Advantage |
$96.12
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cofinity Commercial |
$138.41
|
| Rate for Payer: Cofinity Commercial |
$128.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.12
|
| Rate for Payer: Healthscope Commercial |
$177.82
|
| Rate for Payer: Healthscope Commercial |
$153.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.95
|
| Rate for Payer: Nomi Health Commercial |
$115.34
|
| Rate for Payer: PACE SWMI |
$96.12
|
| Rate for Payer: PHP Medicare Advantage |
$96.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.95
|
| Rate for Payer: Priority Health Medicare |
$96.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.12
|
| Rate for Payer: UHC Medicare Advantage |
$96.12
|
|
|
PR EXCISION NASAL POLYP EXTENSIVE
|
Professional
|
Both
|
$813.00
|
|
|
Service Code
|
HCPCS 30115
|
| Min. Negotiated Rate |
$325.20 |
| Max. Negotiated Rate |
$797.28 |
| Rate for Payer: Aetna Commercial |
$577.49
|
| Rate for Payer: Aetna Medicare |
$448.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$620.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$577.49
|
| Rate for Payer: BCBS Complete |
$325.20
|
| Rate for Payer: BCBS MAPPO |
$430.96
|
| Rate for Payer: BCN Medicare Advantage |
$430.96
|
| Rate for Payer: Cash Price |
$650.40
|
| Rate for Payer: Cash Price |
$650.40
|
| Rate for Payer: Cofinity Commercial |
$620.58
|
| Rate for Payer: Cofinity Commercial |
$577.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$430.96
|
| Rate for Payer: Healthscope Commercial |
$689.54
|
| Rate for Payer: Healthscope Commercial |
$797.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$452.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$528.45
|
| Rate for Payer: Nomi Health Commercial |
$517.15
|
| Rate for Payer: PACE SWMI |
$430.96
|
| Rate for Payer: PHP Medicare Advantage |
$430.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$528.45
|
| Rate for Payer: Priority Health Medicare |
$430.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$430.96
|
| Rate for Payer: UHC Medicare Advantage |
$430.96
|
|
|
PR EXCISION NASAL POLYP SIMPLE
|
Professional
|
Both
|
$497.00
|
|
|
Service Code
|
HCPCS 30110
|
| Min. Negotiated Rate |
$126.21 |
| Max. Negotiated Rate |
$323.05 |
| Rate for Payer: Aetna Commercial |
$169.12
|
| Rate for Payer: Aetna Medicare |
$131.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.12
|
| Rate for Payer: BCBS Complete |
$198.80
|
| Rate for Payer: BCBS MAPPO |
$126.21
|
| Rate for Payer: BCN Medicare Advantage |
$126.21
|
| Rate for Payer: Cash Price |
$397.60
|
| Rate for Payer: Cash Price |
$397.60
|
| Rate for Payer: Cofinity Commercial |
$181.74
|
| Rate for Payer: Cofinity Commercial |
$169.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.21
|
| Rate for Payer: Healthscope Commercial |
$233.49
|
| Rate for Payer: Healthscope Commercial |
$201.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.05
|
| Rate for Payer: Nomi Health Commercial |
$151.45
|
| Rate for Payer: PACE SWMI |
$126.21
|
| Rate for Payer: PHP Medicare Advantage |
$126.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$323.05
|
| Rate for Payer: Priority Health Medicare |
$126.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.21
|
| Rate for Payer: UHC Medicare Advantage |
$126.21
|
|
|
PR EXCISION NEUROMA DIGITAL NRV EA ADDL DIGIT
|
Professional
|
Both
|
$333.00
|
|
|
Service Code
|
HCPCS 64778
|
| Min. Negotiated Rate |
$133.20 |
| Max. Negotiated Rate |
$319.74 |
| Rate for Payer: Aetna Commercial |
$231.59
|
| Rate for Payer: Aetna Medicare |
$179.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.59
|
| Rate for Payer: BCBS Complete |
$133.20
|
| Rate for Payer: BCBS MAPPO |
$172.83
|
| Rate for Payer: BCN Medicare Advantage |
$172.83
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cofinity Commercial |
$248.88
|
| Rate for Payer: Cofinity Commercial |
$231.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.83
|
| Rate for Payer: Healthscope Commercial |
$276.53
|
| Rate for Payer: Healthscope Commercial |
$319.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$181.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.45
|
| Rate for Payer: Nomi Health Commercial |
$207.40
|
| Rate for Payer: PACE SWMI |
$172.83
|
| Rate for Payer: PHP Medicare Advantage |
$172.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.45
|
| Rate for Payer: Priority Health Medicare |
$172.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.83
|
| Rate for Payer: UHC Medicare Advantage |
$172.83
|
|
|
PR EXCISION NEUROMA SCIATIC NERVE
|
Professional
|
Both
|
$3,548.00
|
|
|
Service Code
|
HCPCS 64786
|
| Min. Negotiated Rate |
$978.27 |
| Max. Negotiated Rate |
$2,306.20 |
| Rate for Payer: Aetna Commercial |
$1,310.88
|
| Rate for Payer: Aetna Medicare |
$1,017.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,408.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,310.88
|
| Rate for Payer: BCBS Complete |
$1,419.20
|
| Rate for Payer: BCBS MAPPO |
$978.27
|
| Rate for Payer: BCN Medicare Advantage |
$978.27
|
| Rate for Payer: Cash Price |
$2,838.40
|
| Rate for Payer: Cash Price |
$2,838.40
|
| Rate for Payer: Cofinity Commercial |
$1,408.71
|
| Rate for Payer: Cofinity Commercial |
$1,310.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$978.27
|
| Rate for Payer: Healthscope Commercial |
$1,809.80
|
| Rate for Payer: Healthscope Commercial |
$1,565.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,027.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,306.20
|
| Rate for Payer: Nomi Health Commercial |
$1,173.92
|
| Rate for Payer: PACE SWMI |
$978.27
|
| Rate for Payer: PHP Medicare Advantage |
$978.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,306.20
|
| Rate for Payer: Priority Health Medicare |
$978.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$978.27
|
| Rate for Payer: UHC Medicare Advantage |
$978.27
|
|
|
PR EXCISION OF BULBOURETHRAL GLAND
|
Professional
|
Both
|
$1,137.00
|
|
|
Service Code
|
HCPCS 53250
|
| Min. Negotiated Rate |
$380.05 |
| Max. Negotiated Rate |
$739.05 |
| Rate for Payer: Aetna Commercial |
$509.27
|
| Rate for Payer: Aetna Medicare |
$395.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$547.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$509.27
|
| Rate for Payer: BCBS Complete |
$454.80
|
| Rate for Payer: BCBS MAPPO |
$380.05
|
| Rate for Payer: BCN Medicare Advantage |
$380.05
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Cofinity Commercial |
$547.27
|
| Rate for Payer: Cofinity Commercial |
$509.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$380.05
|
| Rate for Payer: Healthscope Commercial |
$608.08
|
| Rate for Payer: Healthscope Commercial |
$703.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$399.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$739.05
|
| Rate for Payer: Nomi Health Commercial |
$456.06
|
| Rate for Payer: PACE SWMI |
$380.05
|
| Rate for Payer: PHP Medicare Advantage |
$380.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$739.05
|
| Rate for Payer: Priority Health Medicare |
$380.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$380.05
|
| Rate for Payer: UHC Medicare Advantage |
$380.05
|
|
|
PR EXCISION OF PENILE PLAQUE
|
Professional
|
Both
|
$1,186.00
|
|
|
Service Code
|
HCPCS 54110
|
| Min. Negotiated Rate |
$474.40 |
| Max. Negotiated Rate |
$1,104.67 |
| Rate for Payer: Aetna Commercial |
$800.14
|
| Rate for Payer: Aetna Medicare |
$621.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$859.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$800.14
|
| Rate for Payer: BCBS Complete |
$474.40
|
| Rate for Payer: BCBS MAPPO |
$597.12
|
| Rate for Payer: BCN Medicare Advantage |
$597.12
|
| Rate for Payer: Cash Price |
$948.80
|
| Rate for Payer: Cash Price |
$948.80
|
| Rate for Payer: Cofinity Commercial |
$859.85
|
| Rate for Payer: Cofinity Commercial |
$800.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$597.12
|
| Rate for Payer: Healthscope Commercial |
$955.39
|
| Rate for Payer: Healthscope Commercial |
$1,104.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$626.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$770.90
|
| Rate for Payer: Nomi Health Commercial |
$716.54
|
| Rate for Payer: PACE SWMI |
$597.12
|
| Rate for Payer: PHP Medicare Advantage |
$597.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.90
|
| Rate for Payer: Priority Health Medicare |
$597.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$597.12
|
| Rate for Payer: UHC Medicare Advantage |
$597.12
|
|
|
PR EXCISION OLECRANON BURSA
|
Facility
|
IP
|
$612.00
|
|
|
Service Code
|
CPT 24105
|
| Hospital Charge Code |
24105
|
| Min. Negotiated Rate |
$385.56 |
| Max. Negotiated Rate |
$550.80 |
| Rate for Payer: Aetna Commercial |
$520.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$397.80
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cofinity Commercial |
$428.40
|
| Rate for Payer: Cofinity Commercial |
$526.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$428.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.60
|
| Rate for Payer: Healthscope Commercial |
$550.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.20
|
| Rate for Payer: PHP Commercial |
$520.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
| Rate for Payer: Priority Health SBD |
$385.56
|
|
|
PR EXCISION OLECRANON BURSA
|
Facility
|
OP
|
$612.00
|
|
|
Service Code
|
CPT 24105
|
| Hospital Charge Code |
24105
|
| Min. Negotiated Rate |
$385.56 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Commercial |
$520.20
|
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$397.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cofinity Commercial |
$526.32
|
| Rate for Payer: Cofinity Commercial |
$428.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$428.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Healthscope Commercial |
$550.80
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.20
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Commercial |
$520.20
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Priority Health SBD |
$385.56
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,781.56
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
PR EXCISION OLECRANON BURSA
|
Professional
|
Both
|
$612.00
|
|
|
Service Code
|
HCPCS 24105
|
| Hospital Charge Code |
24105
|
| Min. Negotiated Rate |
$244.80 |
| Max. Negotiated Rate |
$643.95 |
| Rate for Payer: Aetna Commercial |
$466.43
|
| Rate for Payer: Aetna Medicare |
$362.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$466.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$501.24
|
| Rate for Payer: BCBS Complete |
$244.80
|
| Rate for Payer: BCBS MAPPO |
$348.08
|
| Rate for Payer: BCN Medicare Advantage |
$348.08
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cofinity Commercial |
$501.24
|
| Rate for Payer: Cofinity Commercial |
$466.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.08
|
| Rate for Payer: Healthscope Commercial |
$556.93
|
| Rate for Payer: Healthscope Commercial |
$643.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.80
|
| Rate for Payer: Nomi Health Commercial |
$417.70
|
| Rate for Payer: PACE SWMI |
$348.08
|
| Rate for Payer: PHP Medicare Advantage |
$348.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
| Rate for Payer: Priority Health Medicare |
$348.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.08
|
| Rate for Payer: UHC Medicare Advantage |
$348.08
|
|
|
PR EXCISION OLECRANON BURSA
|
Professional
|
Both
|
$612.00
|
|
|
Service Code
|
HCPCS 24105
|
| Min. Negotiated Rate |
$244.80 |
| Max. Negotiated Rate |
$643.95 |
| Rate for Payer: Aetna Commercial |
$466.43
|
| Rate for Payer: Aetna Medicare |
$362.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$501.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$466.43
|
| Rate for Payer: BCBS Complete |
$244.80
|
| Rate for Payer: BCBS MAPPO |
$348.08
|
| Rate for Payer: BCN Medicare Advantage |
$348.08
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cofinity Commercial |
$501.24
|
| Rate for Payer: Cofinity Commercial |
$466.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.08
|
| Rate for Payer: Healthscope Commercial |
$556.93
|
| Rate for Payer: Healthscope Commercial |
$643.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.80
|
| Rate for Payer: Nomi Health Commercial |
$417.70
|
| Rate for Payer: PACE SWMI |
$348.08
|
| Rate for Payer: PHP Medicare Advantage |
$348.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
| Rate for Payer: Priority Health Medicare |
$348.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.08
|
| Rate for Payer: UHC Medicare Advantage |
$348.08
|
|
|
PR EXCISION OR FULGURATION SKENES GLANDS
|
Professional
|
Both
|
$402.00
|
|
|
Service Code
|
HCPCS 53270
|
| Min. Negotiated Rate |
$160.80 |
| Max. Negotiated Rate |
$328.67 |
| Rate for Payer: Aetna Commercial |
$238.06
|
| Rate for Payer: Aetna Medicare |
$184.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.06
|
| Rate for Payer: BCBS Complete |
$160.80
|
| Rate for Payer: BCBS MAPPO |
$177.66
|
| Rate for Payer: BCN Medicare Advantage |
$177.66
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cofinity Commercial |
$255.83
|
| Rate for Payer: Cofinity Commercial |
$238.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.66
|
| Rate for Payer: Healthscope Commercial |
$328.67
|
| Rate for Payer: Healthscope Commercial |
$284.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$186.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.30
|
| Rate for Payer: Nomi Health Commercial |
$213.19
|
| Rate for Payer: PACE SWMI |
$177.66
|
| Rate for Payer: PHP Medicare Advantage |
$177.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.30
|
| Rate for Payer: Priority Health Medicare |
$177.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.66
|
| Rate for Payer: UHC Medicare Advantage |
$177.66
|
|
|
PR EXCISION PILONIDAL CYST/SINUS COMPLICATED
|
Professional
|
Both
|
$1,154.00
|
|
|
Service Code
|
HCPCS 11772
|
| Min. Negotiated Rate |
$461.60 |
| Max. Negotiated Rate |
$1,025.27 |
| Rate for Payer: Aetna Commercial |
$742.63
|
| Rate for Payer: Aetna Medicare |
$576.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$798.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$742.63
|
| Rate for Payer: BCBS Complete |
$461.60
|
| Rate for Payer: BCBS MAPPO |
$554.20
|
| Rate for Payer: BCN Medicare Advantage |
$554.20
|
| Rate for Payer: Cash Price |
$923.20
|
| Rate for Payer: Cash Price |
$923.20
|
| Rate for Payer: Cofinity Commercial |
$798.05
|
| Rate for Payer: Cofinity Commercial |
$742.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$554.20
|
| Rate for Payer: Healthscope Commercial |
$1,025.27
|
| Rate for Payer: Healthscope Commercial |
$886.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$581.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$750.10
|
| Rate for Payer: Nomi Health Commercial |
$665.04
|
| Rate for Payer: PACE SWMI |
$554.20
|
| Rate for Payer: PHP Medicare Advantage |
$554.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$750.10
|
| Rate for Payer: Priority Health Medicare |
$554.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$554.20
|
| Rate for Payer: UHC Medicare Advantage |
$554.20
|
|
|
PR EXCISION PILONIDAL CYST/SINUS EXTENSIVE
|
Facility
|
IP
|
$1,343.00
|
|
|
Service Code
|
CPT 11771
|
| Hospital Charge Code |
11771
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$846.09 |
| Max. Negotiated Rate |
$1,208.70 |
| Rate for Payer: Aetna Commercial |
$1,141.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$872.95
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Cofinity Commercial |
$1,154.98
|
| Rate for Payer: Cofinity Commercial |
$940.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$940.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,074.40
|
| Rate for Payer: Healthscope Commercial |
$1,208.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,141.55
|
| Rate for Payer: PHP Commercial |
$1,141.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$872.95
|
| Rate for Payer: Priority Health SBD |
$846.09
|
|
|
PR EXCISION PILONIDAL CYST/SINUS EXTENSIVE
|
Professional
|
Both
|
$1,343.00
|
|
|
Service Code
|
HCPCS 11771
|
| Min. Negotiated Rate |
$433.19 |
| Max. Negotiated Rate |
$872.95 |
| Rate for Payer: Aetna Commercial |
$580.47
|
| Rate for Payer: Aetna Medicare |
$450.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$623.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$580.47
|
| Rate for Payer: BCBS Complete |
$537.20
|
| Rate for Payer: BCBS MAPPO |
$433.19
|
| Rate for Payer: BCN Medicare Advantage |
$433.19
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Cofinity Commercial |
$623.79
|
| Rate for Payer: Cofinity Commercial |
$580.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$433.19
|
| Rate for Payer: Healthscope Commercial |
$801.40
|
| Rate for Payer: Healthscope Commercial |
$693.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$454.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$872.95
|
| Rate for Payer: Nomi Health Commercial |
$519.83
|
| Rate for Payer: PACE SWMI |
$433.19
|
| Rate for Payer: PHP Medicare Advantage |
$433.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$872.95
|
| Rate for Payer: Priority Health Medicare |
$433.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$433.19
|
| Rate for Payer: UHC Medicare Advantage |
$433.19
|
|
|
PR EXCISION PILONIDAL CYST/SINUS EXTENSIVE
|
Professional
|
Both
|
$1,343.00
|
|
|
Service Code
|
HCPCS 11771
|
| Hospital Charge Code |
11771
|
| Min. Negotiated Rate |
$433.19 |
| Max. Negotiated Rate |
$872.95 |
| Rate for Payer: Aetna Commercial |
$580.47
|
| Rate for Payer: Aetna Medicare |
$450.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$580.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$623.79
|
| Rate for Payer: BCBS Complete |
$537.20
|
| Rate for Payer: BCBS MAPPO |
$433.19
|
| Rate for Payer: BCN Medicare Advantage |
$433.19
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Cofinity Commercial |
$623.79
|
| Rate for Payer: Cofinity Commercial |
$580.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$433.19
|
| Rate for Payer: Healthscope Commercial |
$693.10
|
| Rate for Payer: Healthscope Commercial |
$801.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$454.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$872.95
|
| Rate for Payer: Nomi Health Commercial |
$519.83
|
| Rate for Payer: PACE SWMI |
$433.19
|
| Rate for Payer: PHP Medicare Advantage |
$433.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$872.95
|
| Rate for Payer: Priority Health Medicare |
$433.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$433.19
|
| Rate for Payer: UHC Medicare Advantage |
$433.19
|
|
|
PR EXCISION PILONIDAL CYST/SINUS EXTENSIVE
|
Facility
|
OP
|
$1,343.00
|
|
|
Service Code
|
CPT 11771
|
| Hospital Charge Code |
11771
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$846.09 |
| Max. Negotiated Rate |
$7,857.23 |
| Rate for Payer: Aetna Commercial |
$1,141.55
|
| Rate for Payer: Aetna Medicare |
$2,902.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$872.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,489.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,489.12
|
| Rate for Payer: BCBS Complete |
$1,570.94
|
| Rate for Payer: BCBS MAPPO |
$2,791.30
|
| Rate for Payer: BCN Medicare Advantage |
$2,791.30
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Cofinity Commercial |
$1,154.98
|
| Rate for Payer: Cofinity Commercial |
$940.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$940.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,074.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,791.30
|
| Rate for Payer: Healthscope Commercial |
$1,208.70
|
| Rate for Payer: Mclaren Medicaid |
$1,496.14
|
| Rate for Payer: Mclaren Medicare |
$2,791.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,930.86
|
| Rate for Payer: Meridian Medicaid |
$1,570.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,209.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,141.55
|
| Rate for Payer: PACE Medicare |
$2,651.74
|
| Rate for Payer: PACE SWMI |
$2,791.30
|
| Rate for Payer: PHP Commercial |
$1,141.55
|
| Rate for Payer: PHP Medicare Advantage |
$2,791.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,496.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$872.95
|
| Rate for Payer: Priority Health Medicare |
$2,791.30
|
| Rate for Payer: Priority Health SBD |
$846.09
|
| Rate for Payer: Railroad Medicare Medicare |
$2,791.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,857.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,791.30
|
| Rate for Payer: UHC Medicare Advantage |
$2,791.30
|
| Rate for Payer: UHCCP Medicaid |
$1,571.50
|
| Rate for Payer: VA VA |
$2,791.30
|
|
|
PR EXCISION PILONIDAL CYST/SINUS SIMPLE
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
CPT 11770
|
| Hospital Charge Code |
11770
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$327.60 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Aetna Commercial |
$442.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$338.00
|
| Rate for Payer: Cash Price |
$416.00
|
| Rate for Payer: Cofinity Commercial |
$364.00
|
| Rate for Payer: Cofinity Commercial |
$447.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$364.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.00
|
| Rate for Payer: Healthscope Commercial |
$468.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.00
|
| Rate for Payer: PHP Commercial |
$442.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.00
|
| Rate for Payer: Priority Health SBD |
$327.60
|
|
|
PR EXCISION PILONIDAL CYST/SINUS SIMPLE
|
Professional
|
Both
|
$520.00
|
|
|
Service Code
|
HCPCS 11770
|
| Hospital Charge Code |
11770
|
| Min. Negotiated Rate |
$177.76 |
| Max. Negotiated Rate |
$338.00 |
| Rate for Payer: Aetna Commercial |
$238.20
|
| Rate for Payer: Aetna Medicare |
$184.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.97
|
| Rate for Payer: BCBS Complete |
$208.00
|
| Rate for Payer: BCBS MAPPO |
$177.76
|
| Rate for Payer: BCN Medicare Advantage |
$177.76
|
| Rate for Payer: Cash Price |
$416.00
|
| Rate for Payer: Cash Price |
$416.00
|
| Rate for Payer: Cofinity Commercial |
$255.97
|
| Rate for Payer: Cofinity Commercial |
$238.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.76
|
| Rate for Payer: Healthscope Commercial |
$284.42
|
| Rate for Payer: Healthscope Commercial |
$328.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$186.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.00
|
| Rate for Payer: Nomi Health Commercial |
$213.31
|
| Rate for Payer: PACE SWMI |
$177.76
|
| Rate for Payer: PHP Medicare Advantage |
$177.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.00
|
| Rate for Payer: Priority Health Medicare |
$177.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.76
|
| Rate for Payer: UHC Medicare Advantage |
$177.76
|
|
|
PR EXCISION PILONIDAL CYST/SINUS SIMPLE
|
Professional
|
Both
|
$520.00
|
|
|
Service Code
|
HCPCS 11770
|
| Min. Negotiated Rate |
$177.76 |
| Max. Negotiated Rate |
$338.00 |
| Rate for Payer: Aetna Commercial |
$238.20
|
| Rate for Payer: Aetna Medicare |
$184.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.20
|
| Rate for Payer: BCBS Complete |
$208.00
|
| Rate for Payer: BCBS MAPPO |
$177.76
|
| Rate for Payer: BCN Medicare Advantage |
$177.76
|
| Rate for Payer: Cash Price |
$416.00
|
| Rate for Payer: Cash Price |
$416.00
|
| Rate for Payer: Cofinity Commercial |
$255.97
|
| Rate for Payer: Cofinity Commercial |
$238.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.76
|
| Rate for Payer: Healthscope Commercial |
$284.42
|
| Rate for Payer: Healthscope Commercial |
$328.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$186.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.00
|
| Rate for Payer: Nomi Health Commercial |
$213.31
|
| Rate for Payer: PACE SWMI |
$177.76
|
| Rate for Payer: PHP Medicare Advantage |
$177.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.00
|
| Rate for Payer: Priority Health Medicare |
$177.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.76
|
| Rate for Payer: UHC Medicare Advantage |
$177.76
|
|
|
PR EXCISION PILONIDAL CYST/SINUS SIMPLE
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
CPT 11770
|
| Hospital Charge Code |
11770
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$327.60 |
| Max. Negotiated Rate |
$7,857.23 |
| Rate for Payer: Aetna Commercial |
$442.00
|
| Rate for Payer: Aetna Medicare |
$2,902.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$338.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,489.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,489.12
|
| Rate for Payer: BCBS Complete |
$1,570.94
|
| Rate for Payer: BCBS MAPPO |
$2,791.30
|
| Rate for Payer: BCN Medicare Advantage |
$2,791.30
|
| Rate for Payer: Cash Price |
$416.00
|
| Rate for Payer: Cash Price |
$416.00
|
| Rate for Payer: Cofinity Commercial |
$364.00
|
| Rate for Payer: Cofinity Commercial |
$447.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$364.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,791.30
|
| Rate for Payer: Healthscope Commercial |
$468.00
|
| Rate for Payer: Mclaren Medicaid |
$1,496.14
|
| Rate for Payer: Mclaren Medicare |
$2,791.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,930.86
|
| Rate for Payer: Meridian Medicaid |
$1,570.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,209.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.00
|
| Rate for Payer: PACE Medicare |
$2,651.74
|
| Rate for Payer: PACE SWMI |
$2,791.30
|
| Rate for Payer: PHP Commercial |
$442.00
|
| Rate for Payer: PHP Medicare Advantage |
$2,791.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,496.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.00
|
| Rate for Payer: Priority Health Medicare |
$2,791.30
|
| Rate for Payer: Priority Health SBD |
$327.60
|
| Rate for Payer: Railroad Medicare Medicare |
$2,791.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,857.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,791.30
|
| Rate for Payer: UHC Medicare Advantage |
$2,791.30
|
| Rate for Payer: UHCCP Medicaid |
$1,571.50
|
| Rate for Payer: VA VA |
$2,791.30
|
|
|
PR EXCISION PREPATELLAR BURSA
|
Facility
|
IP
|
$1,301.00
|
|
|
Service Code
|
CPT 27340
|
| Hospital Charge Code |
27340
|
| Min. Negotiated Rate |
$819.63 |
| Max. Negotiated Rate |
$1,170.90 |
| Rate for Payer: Aetna Commercial |
$1,105.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$845.65
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cofinity Commercial |
$1,118.86
|
| Rate for Payer: Cofinity Commercial |
$910.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$910.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,040.80
|
| Rate for Payer: Healthscope Commercial |
$1,170.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,105.85
|
| Rate for Payer: PHP Commercial |
$1,105.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$845.65
|
| Rate for Payer: Priority Health SBD |
$819.63
|
|
